Exercising our demons

I’ve just returned from the biennial NZSP conference held over the last two days in Auckland, and I find myself, once again, disheartened by some of the ideas my colleagues are promoting.

Years ago, when I was a junior practitioners and an even more novice qualitative researcher, I would go to physiotherapy conferences hoping to hear the brightest and the best, speaking about cutting edge practice. But rarely did I hear anything about people as people, social theories, politics, disability rights, gender issues, etc. There was never even the slightest mention of anything qualitative to break up the dry diet of quantitative facts and figures. (Those were the days when physiotherapy was starting to obsess about outcome measures and evidence-based medicine – the ‘margarine’ of health care reform.)

Lately though, we’ve been hearing much more about qualitative research in physiotherapy, and it seems all of a sudden physiotherapy has woken up, and there are a lot more people interested in the ‘social context’ of illness, or (God help me) the ‘psychosocial’ aspects of healthcare.

Sadly, rather than this more plural approach to health care heralding in real critical thinking, or even a bit of basic curiosity with what might be going on behind this latest fad, we are now being exposed to the incessant chirruping of well-to-do evangelists who seem obsessed with giving physiotherapists the license to act like Victorian philanthropists and social reformers.

Repeatedly over this weekend I’ve heard people talk about physiotherapy needing to understand:

• the ‘broader social context’ (in principal, I have no problem with this)
• the ‘person’ behind the ‘pathology’ (nor this)
• cultural perspectives (often portrayed as merely ethnic differences)
• the ‘psychosocial’ dimensions of health care (as if they were singular)
• etc., etc.

Physiotherapy, we are told, is uniquely placed to take advantage of the more ‘holistic’ approaches to healthcare that have been heralded by the postmodern world we now live in, because exercise/movement/physiotherapy offers one of the most sustainable, environmentally friendly, drug-free, trustworthy and immensely potent responses to the health problems of today.

But instead of any semblance, and I mean the merest semblance, of critical thinking, we are being fed Billy Graham-esque motivational speeches and worldly-wise insights from people who really should know better: professional leaders who we are surely duty bound to believe, because surely they would know which way we should go?

We’ve moved from having no real interest in the person as a person, to being entranced by the possibilities of treating people like dummies; passive recipients of our ministrations; just waiting for us to bring them the good news about their obesity/poor trunk tone/lack of aerobic fitness, range-of-movement, compliance or adherence.

I heard one eminent advocate for this new wave of neo-liberal clap-trap argue today that we didn’t need any more studies showing us the efficacy of exercise interventions; what we needed was to get out there and start spreading the news! As if people who were fat didn’t already know it. As if people who smoked didn’t already know that we wanted them to quit. As if people who sat too long in front of their computers didn’t already know we thought it was bad for them? (Even though it seems that if you read the work of Nicholas Kendall or Michael Gard it might not be bad for you at all!)

And so, the agenda we are being offered is this:

For those who take the escalator and not the stairs, we will be watching you.

Every time a patient comes to the clinic for exercises for their knee pain, a 21-year-old will be looking at their flabby paunch and giving them advice on how to firm up and stay in shape.

And every time someone goes for treatment on their back, we will be there giving them advice on how to stop smoking, reduce their BMI and control their BP.

There are a few voices out there asking whether this pernicious surveillance medicine is not immensely problematic*, but because physios do not, as a rule, engage with these debates or discussions (preferring instead to bathe in the Coolade of the latest micro-fascistic fashion**), their voices remain, at best, marginal.

This is a real shame, because I believe what seems to be a seductive path to greater social responsibility and kudos, is plotting a course towards the total marginalization of physiotherapy as an effective force for good.

**********

*See Armstrong, D. (1995). The rise of surveillance medicine. Sociology of Health and Illness, 17(3), 393-404.

** O’Byrne, P. & Holmes, D. (2007). From micro-fascism to Plato’s good citizen: producing (dis)order through the construction of risk. Nursing Philosophy, 8, 92-101.

First published by Dave Nicholls on 24 July 2011 via www.criticalphysio.me